Introduction

As the result of an agency initiative, Department on Aging (DoA)/Community Care Program (CCP) service costs are an allowable medical expense for meeting spenddown beginning September 1, 2010. The system centrally takes appropriate action to put the case in met status when DoA/CCP service costs equal or exceed the spenddown amount.

New Notices

HFS 2538C (pdf),Using Department on Aging (DoA) Community Care Program (CCP) Services, will be issued by the FCRC to persons enrolled in spenddown when:

a person has an active medical case and begins receiving DoA services; or

at intake when a person has applied for or is receiving DoA services .

Application Requirement

The CCU sends HFS 2378H, Mail In Application for Medical Benefits, and HFS 2538B (pdf), IDoA Notification, to the Family Community Resource Center (FCRC) when a person is required to apply for medical benefits. Applicants applying for DoA/CCP services must cooperate in providing any verifications needed in determining eligibility for medical benefits.

Using DoA/CCP Services to Meet Spenddown

The cost of DoA/CCP services are an allowable medical expense for meeting spenddown.

DoA/CCP services may not be applied to the spouse's spenddown obligation when a one person standard is used in determining eligiblility.

Separate companion spenddown cases when one of the spouses began receiving DoA services. See PM 15-06-02-d.

FCRCs Use of DoA/CCP Expenses for Meeting Spenddown

When determining spenddown status, consider the estimated amount of DoA/CCP services as incurred on the first day of the month, regardless of the day the services are actually provided. Apply these service costs to spenddown first, before any other medical bills or receipts.

If spenddown is not met for the month in which the charge is incurred, the DoA service costs can be used to meet spenddown for a later month(s). There is no time limit on the use of these service costs. But, once DoA/CCP service costs for a month are used to meet spenddown, the amount remaining from that month cannot be carried over to a later month.

Apply the cost of DoA/CCP services in the month the services were provided or are expected to be provided, or in a future month, if carried over. The CCU will provide Form 2538B to verify the costs of DoA/CCP services when spenddown is not met centrally. Use the amount verified on Form 2538B to meet spenddown beginning with the first month of approval of DoA services. Use the amount provided by the CCU until notified of a change. Consider these expenses incurred as of the first day of the month, regardless of the day the services are actually provided. Use expense Type 'A' in ASDS when entering DoA/CCP service costs.

Meeting Spenddown Centrally with DoA/CCP Services

The computer system will identify clients whose DoA/CCP monthly service costs equal or exceed their monthly spenddown amount. The system centrally takes appropriate action to put the case in met status. This match is done monthly at schedule 08 cut-off.

Mobius Report #R8450469-03 is produced daily and identifies cases that received either a Notice of Determination of Spenddown Met (Form 458SP-2) or a Notice of End of Eligibility for Medical Assistance (Form 3358A). These central notices are sent when cases change centrally between met and unmet status. Use the listing as verification the notices were sent.

Mobius Report #R83003741 is produced monthly. This report identifies cases that have been terminated or indicates that the monthly cost of services received is no longer enough to meet spenddown through the central process.

When DoA services are enough to meet spenddown:

The system changes the Item 80 code 390 met/unmet indicator to a '4'.

The system deletes Item 80 code 396.

The system reduces the amount following Item 80 code 392 to zero, if necessary.

The system changes Item 20 code '16' to '18'. If Item 20 is coded '20' it will not change.

TA 31/TAR A4 is generated.

The system sends Form 458SP-2 to the client.

Note:The FCRC will continue to code Item 20 with '20' when a person at intake has applied for or is receiving DoA services.

When DoA services are terminated or service costs does not meet spenddown:

The system changes the Item 80 code 390 met/unmet indicator to '2'.

The system sends Form 3358A to the customer.

The system changes Item 20 code '18' to '16'.

TA 31/TAR A5 is generated.

When DoA/CCP monthly service costs are not enough to meet spenddown through the central process, the costs may be applied toward spenddown via the ASDS system using expense Type A (Agency In Home Care).

Medical Backdating

DoA/CCP service costs can be used for backdating 3 months prior to 9/01/10. The system will centrally backdate eligibility if the client was receiving DoA/CCP services and the monthly cost equals or exceeds their spenddown amount. The FCRC may apply DoA/CCP service costs to backdate medical when medical was not backdated centrally and the CCU provides HFS 2538B to verify the cost.

Pay-in Spenddown and DoA Services

Persons receiving DoA/CCP services may enroll in Pay-in Spenddown. A person can get a Pay-In Spenddown Enrollment Form (Form HFS 458SP-4) by calling the Healthcare and Family Services (HFS) Hotline at 1-800-226-0768 (TTY: 1-877-204-1012) and asking for the Pay-In Spenddown Unit. See PM 15-08-15.

New TARs

Code

Message

A4

Spenddown obligation met with DHS-DRS/DDD or DoA/CCP service costs.

Central Use Only

A5

Spenddown obligation not met with DHS-DRS/DDD or DoA/CCP service costs.